Doing more to achieve health equity

11.1 The opportunity

Health equity is a key priority for the health and disability system, as outlined in Te Pae Tata – the interim New Zealand Health Plan(external link). Many New Zealanders are not benefiting as much as they could from health and disability services, particularly Māori, Pacific peoples, and disabled people.

Pharmac wants to make the best contribution we can to health equity. This includes implementing the Pae Ora health sector principles and working closely with others across the health and disability system.

Advancing Māori health is a key priority. We also need to better meet the health needs of other priority groups, including Pacific peoples and those with disabilities. Collective action is needed from the health and disability system to address these inequities, including barriers to accessing medicines and related products. Pharmac is in a better position than ever to contribute effectively and facilitate change because:

• the Pae Ora (Healthy Futures) Act makes addressing health inequity a priority objective for the entire health and disability system
• new national entities make improved coordination a much more realistic prospect.

See the collaboration section for more about how we want to work with others to deliver on these ambitions.

11.2 Titiro whakamua – the path ahead

Addressing inequity of health outcomes requires every part of Pharmac to reconsider how it works. Our future work will include:

• centring equitable health outcomes in all our work
• maximising what management of the Pharmaceutical Schedule can contribute
• facilitating collective action to improve access to and optimal use of medicines
• working more actively with others to enhance monitoring and actionable insights on uptake and use of medicines and devices
• increasing diverse voices in our work and our own visibility to priority communities.

While our initial focus is on medicines and related products, many of the issues and challenges will also be the same for our hospital medical devices work.

11.2.1 Centre equitable health outcomes in all our work

While we know what we want to achieve, we still need to develop the specifics about how to incorporate equity considerations across our work. For Pacific peoples, for example, they have made their expectations very clear in Lalanga Fou report (2018)(external link), specifically Goal 3: Healthy and resilient Pacific communities. Our future work will include:

• better incorporating equity considerations into strategies, policies, and approaches to our work
• defining performance measures to demonstrate we are delivering on equity
• embedding diverse voices across our own work and in our expert advisory network
• reviewing the Factors for Consideration, Pharmac’s decision-making framework, that we apply to assess, prioritise, and decide on what’s funded
• working with other agencies to get the data and evidence we need to support our decision making, including New Zealand specific information for Māori, Pacific, and other priority populations
• working in partnership with Māori to pursue health equity.

11.2.2 Maximise what management of the Pharmaceutical Schedule can contribute

Deciding which medicines and related products, and in the future hospital medical devices, will be publicly funded is Pharmac’s core role. New Zealanders expect us to make evidence based, high-quality decisions that will deliver the best health outcomes. It’s essential that equity considerations are embodied in this work. See the section on enhancing our assessment and decision making for more detail.

While we strive to improve health equity, we must acknowledge that the mechanisms available to us through the Schedule cannot address all inequitable health outcomes. This underscores the importance of the other parts of this priority, such as collective action on how the Schedule is used.

The reasons for inequity are complex. Addressing inequity requires a whole system approach, Pharmac is committed to working with a wide range of agencies and stakeholders to influence positive change. The interim Government Policy Statement on Health outlines the outcomes needed from the entire health and disability system to create more equitable outcomes.

11.2.3 Facilitate collective action to improve access to and optimal use of medicines

Many agencies and stakeholders have vital roles to play in making the best use of medicines and related products. The need for coordination to get better health outcomes from funded medicines has historically been a barrier. The health reforms and creation of new national entities now makes coordination much more possible.

Pharmac is keen to actively support improved use of medicines and hospital medical devices. We are well placed to play a facilitative role given our place within the system, and our own interest in the investments we make being used as effectively as possible.

Collective initiatives, such as the Joint Venture for Eliminating Family Violence and Sexual Violence and cross-agency work to reduce child poverty, show how a cross government approach can improve alignment and be effective. Health sector examples include the safer prescribing hui from Manatū Hauora and the new immunisation governance group. The Public Service Act 2020 also offers tools to support collaboration, which may over time be useful to consider.

11.2.4 Work more actively with others to enhance monitoring and actionable insights

Manatū Hauora, Te Whatu Ora, Te Aka Whai Ora, and the Health Quality and Safety Commission play important roles in monitoring the health and disability system and providing insights about performance and possible improvement.

Pharmac could play a greater role alongside others in monitoring and assessing how medicines and medical devices are used – and in identifying priorities for improving access and use.

11.2.5 Increase diverse voices in our work and our own visibility to priority communities

Pharmac is committed to diversity in its staff and expert advisory network, and to actively seeking diverse perspectives when we engage.

We are already making progress but have more to do. We want to better understand the experience, views, and challenges of priority populations.

This is a vital component of our response; each section touches on the need for more diverse voices in our work and how we plan to address it.

11.2.6 Getting started on our path – our 2022/23 commitments

For 2022/23, our specific commitments to move forward on this priority are:

19. complete our equity policy to make clear how equity considerations relate to our work

20. explore how we can better meet the needs and interests of disabled people across our work (such as related to data-collection and our work on diversity and inclusion)

21. work further to build an inclusive work environment where all people feel they belong and can be their best – supporting both our current workforce and helping to attract additional diversity when we recruit new staff

22. increase the diversity of our expert advisory network

23. evaluate how our recent insight reports, and use of the underlying monitoring framework, have been received and utilised by other key agencies and stakeholders, to better understand the demand and clinical relevance of such reports.

24. support Te Aka Whai Ora to develop its role in monitoring system performance, including in relation to hauora Māori, and consider where our own analytical effort and sharing of data and insights are best directed to enhance system knowledge.

As noted in the priority area of enhanced assessment and decision making (section 9), we are also working to further improve how equity considerations are embedded into funding assessment work and the decisions we make.